Specialists take on growing problems of diabetes

The scale of the challenge posed by diabetes is vast and the number of sufferers across Oxfordshire is rising.

Ten years ago there were 18,235 people aged 17 and over diagnosed with the condition in the county.

But figures for 2012/13, the most recent available, show some 26,109 people were living with diabetes in Oxfordshire. County experts estimate six per cent of people have the condition and predict this will rise to 7.2 per cent by 2020.

The Oxford Centre for Diabetes, Endocrinology and Metabolism opened in 2003 and is a hive of activity for the condition.

Tucked away at the back of Headington’s Churchill Hospital, it treats county patients and carries out vital research and clinical work, like preparing cells for transplant.

Bosses want to make sure it is up to the challenge. Oxford University Hospitals NHS Trust this year announced an extra £535,000-a-year investment in staff.

This will include increasing full-time podiatry roles – diabetes can reduce blood supply to the foot – from one to four.

They also aim to double the number of specialist nurses to eight and increase the number of consultants from six to nine.

Senior clinical researcher and honorary consultant Katharine Owen blamed the rise on the “increasing prevalence of obesity and sedentary lifestyles”.

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She said: “When people first get diabetes it can feel devastating because, all of a sudden, your lifestyle becomes much more complicated.

“You constantly know that if you don’t keep it under control you are going to have health complications.

“There is a lot of anger and denial and not wanting to accept they have diabetes.

“Part of our role is helping people come to terms with that and show them it can be managed.”

Depending on the severity of their condition, sufferers can visit once a month or once a year for advice.

Patients can also get checks like blood pressure and blood tests, some of the information from which is shared with the patient’s GP.

She said it can be “incredibly difficult” to get people to manage their condition, from keeping track of carbohydrates in foods like potatoes and pasta, to taking injections.

“It is not very pleasant to give yourself an injection and to take a finger prick blood test before you eat.

“It is really hard work.”

When it comes to prevention, she said: “We would encourage people who are overweight to have a more healthy diet, more fruit and veg, less processed food and to get more activity into their everyday life.

“It is an incredible struggle, it is very, very hard to lose weight. Some cannot make the lifestyle change.

“When you are carrying too much weight you are not using insulin very efficiently, which means you can’t handle sugar well.

“The best thing to do is not to become overweight in the first place.”

About nine in 10 diabetes cases are known as type 2, where the body does not produce enough insulin or the body’s cells do not react to insulin.

Insulin is a hormone, produced by the pancreas, that controls the amount of sugar in the blood.

When food enters the bloodstream after being digested, insulin takes glucose out and puts it into cells which later produce energy.

But diabetics are unable to break down the glucose and type 2 sufferers usually control symptoms by eating more healthily, monitoring their blood glucose level and, if their condition worsens, taking tablets.

In type 1, the body’s immune system destroys cells that produce insulin meaning glucose levels increase and lead to a risk of damaging blood vessels, nerves and organs.

The condition is mostly thought to be genetic and usually affects people aged 40 and under, often during teenage years, and sufferers take insulin injections for the rest of their lives.

Treatment

DIABETES is mostly treated through advice, medication and insulin, though some rare type 1 cases have islet transplantation.

This involves taking insulin-producing cells from a donor’s pancreas and transplanting them into the liver through injection. This is particularly aimed at people at risk of life-threatening hypoglycaemic attacks.

Clinical research fellow Basil Bekdash, pictured, said: “Rather than a whole organ transplant we go a slightly different route.

“We break the organ down and we take the small one or two per cent that makes the insulin and other hormones and give that back as a transplant.”

ANALYSING DATA

The centre’s Dexa scanner uses x-rays to research how levels of fat in the abdomen can affect a patient’s diabetes.

Diana Mantrip

Diabetes research nurse Diana Mantrip says this means the pancreas can be “squished up so it is not working so efficiently”. The centre has stored patient records of 4,000 people since 2000 as part of its research and the scanner arrived in 2006.

She said: “When the heart beats it is beating against more resistance.

“Different people store different amounts of fat. A very slim person may store a high proportion of the little fat they have in their abdomen, whereas someone who is very obese may store the right amount in the right place.”

‘I drew the short straw’

A SCRATCH to her wrist from her cat led to a shock diagnosis for Headington’s Margaret Simpson.

Margaret Simpson

The 72-year-old had a blood test which found she had type 2 diabetes and, despite twice-daily insulin injections, she has carried on with her life.

The retired homeless charity manager said: “I had no signs and symptoms so it seems I drew the short straw in my family. I walked a minimum of five miles a day with my dog, I swam two or three times a week, I had what was considered a healthy lifestyle and my diet was okay.

“I was exceptionally surprised. I just laughed when the doctor said it.

“I thought my brother was the one who should have drawn the short straw.”

Diagnosis via video-link

RESEARCHERS hope this video device will help medics better spot if a sufferer is at risk of a hypoglycaemic event, drowsiness or even of losing consciousness.

The subject has to keep completely still so a camera can detect changes in skin colour and their breathing from expansion of the chest.

Alessandro Guazzi

It is being developed by Oxford University’s Institute of Biomedical Engineering as an alternative to testing blood by pricking the finger.
Alessandro Guazzi, who has helped develop the technology, said: “The idea is to have a way of detecting vital signs without having any contact with the patient.”

He said of the finger prick test: “There are problems with infection and you only have one sample every ‘x’ minutes rather than have it constantly measured.”

Among those trying out the technology was Jackie Bushell, 57, of Didcot, who recorded a beats-per-minute heart rate of 70 and a breathing rate of 11.

She has to regularly check her heart rate for her hypothyroidism, where the thyroid gland does not produce enough hormones.

She said: “It is good, it is very useful. It is an absolute boon for patients not to have to be hooked up.”

DNA plays role in finding facts

EXTRACTING DNA from strawberries is a simple way of showing how researchers hope genetics will unlock the secrets of diabetes.

Alex Hamilton

Centre research technician Alex Hamilton, 22, demonstrated how mashing up the fruit, adding salt and washing-up liquid, running it through a filter and adding ethanol could extract the building blocks of life.

He said: “It is to show how easy it is to get DNA from something.
“If you have a diabetic patient and someone who is healthy, you take the blood and the DNA from them so you can look at the genes and see if they differ.

“Type 1 and type 2 have genetic influences as well as environmental influences.

“We understand it a reasonable amount but I think as we discover more it gets more complicated.”

ISLET CELLS

MAHDIEH Godazgar, 22, has been at the centre for a year as part of a PhD and spoke to visitors about the study of islet cells.

Mahdieh Godazgar

She said: “Metabolism is really important if you think about it. Everything in your body relies on your production of adenosine tri-phosphat, which is produced by glucose.”

The machine – which would retail to sufferers for £100 to £200 – would gather breath molecules which would then be analysed by a laser in a shoeboxed-size companion machine.

Tom Blaikie technical officer at the Begbroke Business & Science Park firm, said it is another alternative to testing through blood finger pricks for diabetic ketoacidosis, a potentially dangerous complication of diabetes.

He said: “The admissions for this condition are incredibly costly for the NHS. Doctors are keen to prevent admissions.”

‘It’s not easy cutting out sweet stuff’

RETIRED IT manager Bernard Gudgin said it was not easy avoiding biscuits put out at meetings after being diagnosed as type 2 some 12 years ago.

The Didcot resident, left, said: “I was having some trouble with my eyes and went to the eye hospital where they did a retina scan and blood tests.

Bernard Gudgin

“It showed my blood sugar was higher than it should have been. I wasn’t expecting it at all. I went to my GP and he did some further tests and confirmed it was type 2.”

Mr Gudgin, 66, had no further problems with his eyes after treatment, which now involves him taking four types of tablets a day.

He added: “You have to essentially cut out sugars and carbohydrates.

“I suppose the worst thing was biscuits. I was working full-time at the time and when there was a plate of biscuits on the table I had to let them pass by. It means not having things like chocolate and ice cream.

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“The other thing people might not be aware of is that a lot of processed foods from the supermarket contain a lot of sugar.”

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